public health nurse to do all necessary followup of referrals; (3) a focal organization countywide in scope which will be willing to work with the State health department in publicity and promotion and to furnish voluntary appointment chairmen and hostesses. From the beginning of this local support activity, through screening and followup, education is stressed. Creating an awareness of the need and encouraging citizens to take the responsibility for early detection in their health care program constitute a focal point of our educational effort. When, as a result of the screening test, a previously undiagnosed condition is suspected the screenee is referred directly to his private physician. Local health department nurses follow the case to its conclusion.

Data processing equipment and automated analysis equipment have been used where feasible. Highly sophisticated computer processes have not yet been found desirable here. However, as our aged population increases, the benefits of additional speed will be recognized.

We will endeavor to answer your questions in the order in which they were asked in your letter of August 18:

(1) In the above brief description and with enclosed references, we feel this question has been answered.

(2) As far as prevalence of chronic diseases within our State according to age groups is concerned, we do not have figures other than our breakdown showing positive findings on persons screened. These figures are shown in table 6 of the enclosed reprint.

(3) Screening programs are valuable in certain population groups. We feel that screening procedures should be available for most persons over age 35. In certain individuals, such as the very obese and blood relatives of diabetics, this age level should be lowered.

(4) In the Oklahoma State Department of Health, Dr. C. M. Bloss, chief, preventive medical services; Mr. Bill Burk, head of field services; Miss Alwyn Lamont, supervising nurse; and Dr. Forest R. Brown, chief, community health services, all have knowledge and are interested in this subject.

(5) We feel, based upon our experience, that there is a need for multiphasic health screening for certain diseases where the yield is significant. These screening programs should be coordinated with across-the-board health education programs; sophisticated to the extent of acceptance by the local medical community; and stressed as being screening programs-not diagnostic clinics.

Since initiation of multiphasic screening in Oklahoma, 36 of our 77 counties have been covered more than 100,000 persons have been examined, and approximately 425,000 tests have been performed. We feel that the lay public is extremely interested in health conservation when it is properly and adequately presented to them. We also feel that multiphasic health screening is an important part of health maintenance and that the need for it will continue to grow.

While it is desirable that more recent and sophisticated testing equipment be made available for use in large population areas, we feel that some provision should be made for reaching the rural areas. In Oklahoma our highest per centum of aged people are found in the rural counties. The mobile unit is the only means we have of offering multiphasic screening at this time. However, we do plan to expand

our diabetes and cervical cancer detection program as a part of regularly scheduled on-going programs in local areas; this has already been accomplished in several counties. On-going glaucoma screening programs have been established in nine county health departments. The fact that our program has been well accepted and is in continuous demand throughout the State indicates some satisfaction from both lay and professional groups.

We would be happy to have a representative (s) from Oklahoma meet with your committee, if you desire. We have recently completed the production of a 16-millimeter motion picture film (14 minutes) which shows how the multiphasic program is organized and operated in Oklahoma. If you desire its use, we will be happy to reserve it for you.

Sincerely yours,

KIRK T. MOSLEY, M.D.,
Commissioner of Health.

Results of multiphasic screening in 12 Oklahoma counties, 1960–62

STATE OF OKLAHOMA.

DEPARTMENT OF PUBLIC WELFARE, OKLAHOMA PUBLIC WELFARE COMMISSION, Oklahoma City, Okla., September 1, 1966.

Hon. MAURINE B. NEUBERGER,

Chairman, Subcommittee on Health of the Elderly, U.S. Senate, Washington, D.C.

DEAR SENATOR NEUBERGER: Please refer to your correspondence dated August 18, 1966, regarding the beginning of a study of modern health screening methods intended to detect and thus help prevent chronic illness. I was pleased to hear about your study and feel that methods of prevention of disabilities from chronic illness is certainly of great significance in public health problems of today.

Personnel from the State health department were contacted since they are responsible for the development and use of modern health screening methods. It was found that their reply to your request of them included statistics, as well as methods of screening used. It would appear from the State health department's reply to you that the only additional information we would be able to offer would be on questions 4 and 5.

The following people, we feel, have special knowledge of or interest in this subject:

Dr. John W. DeVore, president of the Senior Citizens Foundation, Inc., 1214 North Hudson, Oklahoma City, Okla., who has placed interest in and emphasis on rehabilitation and aging;

Rev. Joseph Shackford, assistant pastor, St. Luke's Methodist Church, 15th and North Robinson, Oklahoma City, Okla.;

Mr. L. O. Parsons, State chairman of the National Association for Retired Civil Service Employees, 2124 Barclay Road, Oklahoma City, Okla.;

Mr. H. V. Grietz, State chairman of the American Association of Retired Persons, 1417 North Drexel, Oklahoma City, Okla.; and, The State Information and Referral Service, 624 15th Street NE., Oklahoma City, Okla.

The above-named persons and organizations have been very instrumental in helping develop interest in and education of persons in the community for the multiphasic screening clinics to be scheduled for and carried on in the different areas of the State.

In relation to any particular impediments to the acceptance of the program by the public and medical profession, I feel that impediments are the result of lack of knowledge. Based on the results of the number of counties covered in the State and the number of persons reached, it would appear any such impediments would be overcome by a well-organized educational program in the community where screening would be held, and including key people, as well as agencies, in this program. It would appear that multiphasic health screening is an important part of health maintenance, and with a continued growth of enlightening the public, the need will continue to grow.

We are happy to provide you with the information, and should you feel the need for further information, please let us know and we shall be happy to provide it.

Sincerely,

L. E. RADER, Director of Public Welfare.

STATE OF OREGON,

OREGON STATE BOARD OF HEALTH,
Portland, Oreg., September 7, 1966.

Senator MAURINE B. NEUBERGER,

Chairman, Subcommittee on Health of the Elderly,
Special Committee on Aging,

U.S. Senate,
Washington, D.C.

DEAR SENATOR NEUBERGER: This is in reply to your letter of August 18, 1966, relative to the hearing on September 20, 21, and 22, 1966, before the Special Committee on Aging relative to comprehensive screening programs.

While prevention of disease and amelioration of crippling or handicapping condition is a prime responsibility of public health and while we have considerable knowledge, in many instances, of how this can be accomplished we have not, in Oregon, progressed as much as we should have liked. Screening programs are not new to public health and some, as for instance the mass X-ray screening for pulmonary tuberculosis and blood testing for syphilis, have been promulgated, proposed, and successfully carried out. Those in the area of chronic disease are relatively new and not accepted by the groups who must of necessity plan and carry out the programs. We shall expand on this later in answer to your fifth question.

It is perhaps pertinent that the chronic disease section of the Oregon State Board of Health is not quite 3 years old and that it has taken some time to recruit an adequate staff and get various program activities initiated.

Question No. 1

The Oregon State Board of Health has carried out several screening programs which have been of value in gaining experience and in pointing up the value of such programs.

Diabetes screening. During 1965, a total of 5,928 persons had blood tests for elevated blood sugar; 1,157 were suspicious and referred to their private physician and 216 were diagnosed as new cases of diabetes (see attachment No. 1). The followup on the suspicious screenees was not entirely satisfactory as 454 of the 1,157 referred (37 percent) either did not see their physician or the physician failed to make a report of his findings. Of the 703 persons on whom we obtained followup reports, 216 or 30.7 percent were diagnosed as new cases of diabetes. This figure is about twice as high as the national figure. At the present time we have no explanation for this high figure.

We should like to point out that the Oregon State Board of Health has just recently approved a statewide diabetes program consisting of (1) public education, (2) patient education, (3) professional education, and (4) mass screening. We hope eventually to screen 40,000 to 50,000 individuals each year.

Vision screening. In 1964, we undertook to do vision screening on residents of nursing homes and homes for the aged in the Portland metropolitan area (see attachment No. 2). In 114 facilities in the 5 county area 3,344 or 70 percent of the residents were screened and 2,309 or 69 percent were referred for further examination, again higher than the apparent national figures.